老年人蛛网膜下腔出血的误诊分析  

Analysis on Misdiagnosis of Elderly Subarachnoid Haemorrhage:a Report of 30 Cases

作　　者：郝丽[1] 邹和苓 

机构地区：[1]云南省昆明市延安医院急诊科,650051

出　　处：《中华全科医学》2011年第4期566-566,583,共2页Chinese Journal of General Practice

摘　　要：目的探讨蛛网膜下腔出血(SAH)的临床症状及误诊情况。方法回顾分析误诊的30例SAH病例的临床临床表现、误诊情况及转归。结果本组30例中,昏迷5例(16.7%),头剧痛8例(27.0%),隐痛4例(13.3%),恶心呕吐11例(37.0%),眩晕5例(16.7%),精神障碍3例(10.0%),发作性抽搐2例(6.7%),嗜睡1例(3.3%),以头痛、恶心呕吐多见;30例患者误诊为急性胃肠炎3例(10.0%),梅尼埃病4例,椎基底动脉供血不足5例(16.7%),颈椎病4例(13.3%),晕厥3例(10.0%),高血压脑病4例(13.3%),自主神经功能紊乱2例(6.7%),癫痫发作2例(6.7%),脑炎1例(3.3%),老年精神病2例(6.7%)。延误诊断1 d者16例(53.3%)2,d者9例(30.0%)3,d者4例(13.3%),其中1例(3.3%)误诊时间长达19 d。30例患者经头颅CT或腰穿检查确诊为蛛网膜下腔出血。结论老年人SAH临床表现不典型,复杂多样,易导致误诊。对于高度怀疑而且头颅CT检查阴性的患者,根据情况行腰穿脑脊液检查,必要时行数字减影血管造影(DSA)检查,以早期明确诊断。Objective To investigate the clinical features and misdiagnosis of subarachnoid haemorrhage （SAH）. Methods The clinical symptoms, misdiagnosis and outcome findings of 30 cases with SAH were analyzed retrospectively. Results Among the 30 misdiagnosed cases ： 5 cases were with coma （ 16.7% ） , 8 cases with head pain （ 27. 0% ） , 4 cases with dull pain （ 13.3% ） , 11 cases with nausea and vomiting （ 37.0% ） , 5 cases with dizziness （ 16. 7% ） 3 cases with＇ mental disorders （10.0%） ,2 cases with paroxysmal convulsion（6.7% ）,1 case with lethargy（3.3% ）. 3 cases were misdiagnosed as acute gastroenteritis（ 10.0% ） ,4 cases as Meniere＇ s disease,5 cases as vertebral basilar insufficiency（ 16.7% ） ,4 cases as cervical disease（ 13.3% ） ,3 cases as syncope（ 10.0% ） ,4 cases as hypertensive encephalopathy（ 13.3% ） ,2 case autonomic nerve dysfunction （6.7 % ） ,2 cases as seizures （6.7 % ）, 1 case as encephalitis （ 3.3 % ）, 2 cases as senile psychosis （ 6.7 % ）. The diagnosis delayed one day in 16 cases（53.3% ） ,two days in 9 cases（30.0% ） ,three days in 4 cases（ 13.3% ） ,and at least 19 days in 1 patient（3.3 % ）. All 30 patients were confirmed by head CT or lumbar puncture as subarachnoid hemorrhage. Conclusion Senile SAH,without typical clinical symptoms,is easy to be misdiagnosed. For the highly suspected cases and negative cases by CT, the examination of cerebrospinal fluid, some time DSA, is necessary for the confirmed diagnosis of SAH.

关 键 词：蛛网膜下腔出血 临床表现 误诊 

分 类 号：R743.35[医药卫生—神经病学与精神病学]